Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-05T16:04:31.989Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethics of Clinical Decision-Making for Older Drivers: Reporting Health-Related Driving Risk

Published online by Cambridge University Press:  27 April 2016

Barbara Mazer ,
Maude Laliberté ,
Matthew Hunt ,
Josée Lemoignan ,
Isabelle Gélinas ,
Brenda Vrkljan ,
Gary Naglie  and
Shawn Marshall
Barbara Mazer*
Affiliation:
Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) – site Jewish Rehabilitation Hospital, Laval
Maude Laliberté
Affiliation:
Faculté de médecine, École de réadaptation, Université de Montréal, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
Matthew Hunt
Affiliation:
Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) – site Jewish Rehabilitation Hospital, Laval
Josée Lemoignan
Affiliation:
Faculté de médecine, École de réadaptation, Université de Montréal, and Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
Isabelle Gélinas
Affiliation:
Faculty of Medicine, School of Physical and Occupational Therapy, McGill University Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) – site Jewish Rehabilitation Hospital, Laval
Brenda Vrkljan
Affiliation:
School of Rehabilitation Science, McMaster University
Gary Naglie
Affiliation:
Department of Medicine and Rotman Research Institute, Baycrest Health Sciences; Research Department, Toronto Rehabilitation Institute, University Health Network Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto
Shawn Marshall
Affiliation:
Ottawa Hospital Research Institute, University of Ottawa
*
†La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Barbara Mazer, Ph.D. CRIR-Jewish Rehabilitation Hospital 3205 Place Alton Goldbloom Laval, QC H7V 1R2 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

The number of older drivers will continue to increase as the population ages. Health care professionals have the responsibility of providing care and maintaining confidentiality for their patients while ensuring public safety. This article discusses the ethics of clinical decision-making pertaining to reporting health-related driving risk of older drivers to licensing authorities. Ethical considerations inherent in reporting driving risk, including autonomy, confidentiality, therapeutic relationships, and the uncertainty about determining individual driving safety and risk, are discussed. We also address the moral agency of reporting health-related driving risk and raise the question of whose responsibility it is to report. Issues of uncertainty surrounding clinical reasoning and concepts related to risk assessment are also discussed. Finally, we present two case studies to illustrate some of the issues and challenges faced by health care professionals as they seek to balance their responsibilities for their patients while ensuring road safety for all citizens.

Résumé

Le vieillissement de la population engendre une augmentation du nombre de conducteurs âgés. Les professionnels de la santé ont la responsabilité de fournir des soins en préservant le secret professionnel tout en assurant la sécurité du public. Cet article traite de l’analyse éthique relative à la prise de décisions en lien avec le signalement aux autorités compétentes des conducteurs âgés identifiés comme étant à risque. Des considérations éthiques inhérentes au signalement des conducteurs à risque sont traitées, telles que l’autonomie, le secret professionnel, la relation thérapeutique et l’incertitude associée à l’évaluation de la conduite automobile. Nous abordons également la question de la responsabilité des divers agents moraux. L’incertitude entourant le raisonnement clinique et les concepts liés à l’évaluation du risque sont également traités. Enfin, nous présentons deux cas illustrant certains défis auxquels sont confrontés les professionnels de la santé dans l’atteinte d’un équilibre entre leurs responsabilités face à leurs patients et celles visant à assurer la sécurité du public.

Keywords

vieillissementconduite automobileévaluationéthique cliniqueagingdrivingassessmentclinical ethics
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 35 , Special Issue S1: Older Driver Research: Evidence to Guide Change / Recherche sur la conduite automobile des personnes âgées : des preuves afin de guider le changement , June 2016 , pp. 69 - 80
Check for updates
Copyright
Copyright © Canadian Association on Gerontology 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anstey, K. J., Wood, J., Lord, S., & Walker, J. G. (2005). Cognitive, sensory and physical factors enabling driving safety in older adults. Clinical psychology review, 25(1), 45–65.Google Scholar
Appel, J. (2009). Must physicians report impaired driving? Rethinking a duty on a collision course with itself. Journal of Clinical Ethics, 20(3), 136–140.Google Scholar
Asimakopulos, J., Boychuck, Z., Sondergaard, D., Poulin, V., Ménard, I., & Korner-Bitensky, N. (2012). Assessing executive function in relation to fitness to drive: A review of tools and their ability to predict safe driving. Australian Occupational Therapy Journal, 59(6), 402–427.Google Scholar
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics. Don Mills, ON: Oxford University Press.Google Scholar
Canadian Medical Association. (2012). CMA driver’s guide: Determining medical fitness to operate motor vehicles. Ottawa, ON: Government Printing Office.Google Scholar
CBC News. (2014, April 8) Seniors behind the wheel: Are you concerned? CBC News. Retrieved from http://www.cbc.ca/news/canada/british-columbia/seniors-behind-the-wheel-are-you-concerned-1.2602924 Google Scholar
Dickerson, A. E., Molnar, L. J., Eby, D. W., Adler, G., Bédard, M., Berg-Weger, M., et al. (2007). Transportation and aging: A research agenda for advancing safe mobility. The Gerontologist, 47(5), 578–590.Google Scholar
Eberhard, J. (2008). Older drivers’ high per-mile crash involvement: The implications for licensing authorities. Traffic Injury Prevention, 9(4), 284–290.CrossRefGoogle ScholarPubMed
Fain, M. J. (2003). Should older drivers have to prove that they are able to drive? Archives of Internal Medicine, 163(18), 2126–2128.Google Scholar
Fitten, L. J. (2003). Driver screening for older adults. Archives of Internal Medicine, 163(18), 2129.CrossRefGoogle ScholarPubMed
Frucht, S., Rogers, J., Greene, P., Gordon, M., & Fahn, S. (1999). Falling asleep at the wheel: Motor vehicle mishaps in persons taking praimpexole and ropinirole. Neurology, 52, 1908–1910.CrossRefGoogle ScholarPubMed
Heikkila, V. M., Turkka, J., Korpelainen, J., Kallanranta, T., & Summala, H. (1998). Decreased driving ability in people with Parkinson’s disease. Journal of Neurology and Neurosurgery Psychiatry, 64, 325–330.Google Scholar
Hoggarth, P. A., Innes, C. R., Dalrymple-Alford, J. C., & Jones, R. D. (2013a). Prospective study of healthy older drivers: No increase in crash involvement or traffic citations at 24 months following a failed on-road assessment. Transportation Research Part F: Traffic Psychology and Behaviour, 16, 73–80.Google Scholar
Hoggarth, P. A., Innes, C. R., Dalrymple-Alford, J. C., & Jones, R. D. (2013b). Predicting on-road assessment pass and fail outcomes in older drivers with cognitive impairment using a battery of computerized sensory-motor and cognitive tests. Journal of the American Geriatrics Society, 61(12), 2192–2198.CrossRefGoogle ScholarPubMed
Hopewell, C. A. (2002). Driving assessment issues for practicing clinicians. The Journal of Head Trauma Rehabilitation, 17(1), 48–61.Google Scholar
Hunt, M. R., & Ells, C. (2011). Partners towards autonomy: Risky choices and relational autonomy in rehabilitation care. Disability and Rehabilitation, 33(11), 961–967.CrossRefGoogle ScholarPubMed
Insurance Institute for Highway Safety. (2008). Older drivers’ fatal crashes trend down, Status Report, 43(11). Arlington, VA: Author.Google Scholar
Insurance Institute for Highway Safety. (2014). Fit for the road: Older drivers’ crash rates continue to drop, Status Report, 49(1). Arlington, VA: Author.Google Scholar
Iverson, D., Gronseth, G., Reger, M., Classen, S., Dubinsky, R., & Rizzo, M. (2010). Practice parameter update: Evaluation and management of driving risk in dementia. Report of the Quality Standards Subcommittee of the American Academy of Neurology, Neurology, 74(16), 1316–1324.CrossRefGoogle Scholar
Kay, L. G., Bundy, A. C., Clemson, L., Cheal, B., & Glendenning, T. (2012). Contribution of off-road tests to predicting on-road performance: A critical review of tests. Australian Occupational Therapy Journal, 59(1), 89–97.Google Scholar
Li, G., Braver, E. R., & Chen, L. H. (2003). Fragility versus excessive crash involvement as determinants of high death rates per vehicle-mile of travel among older drivers. Accident Analysis and Prevention, 35(2), 227–235.CrossRefGoogle ScholarPubMed
Lord, S., Despres, C., & Ramadier, T. (2011). When mobility makes sense: A qualitative and longitudinal study of the daily mobility of the elderly. Journal of Environmental Psychology, 31(1), 52–61.Google Scholar
Marottoli, R. A., de Leon, C. F. M., Glass, T. A., Williams, C. S., Cooney, L. M., & Berkman, L. F. (2000). Consequences of driving cessation decreased out-of-home activity levels. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 55(6), S334–S340.Google Scholar
Marottoli, R. A., & Richardson, E. D. (1998). Confidence in, and self-rating of, driving ability among older drivers. Accident Analysis and Prevention, 30(3), 331–336.Google Scholar
Marshall, S. C. (2008). The role of reduced fitness to drive due to medical impairments in explaining crashes involving older drivers. Traffic Injury Prevention, 9(4), 291–298.Google Scholar
Murdock, S. (2014). ‘Stop driving,’ says daughter of woman killed by elderly driver. Huffington Post. Retrieved from http://www.huffingtonpost.com/2014/04/09/doreen-landstra-driver_n_5111264.html Google Scholar
Myers, A. M., Trang, A., & Crizzle, A. M. (2011). Naturalistic study of winter driving practices by older men and women: Examination of weather, road conditions, trip purposes, and comfort. Canadian Journal on Aging, 30(4), 577–589.Google Scholar
Newbold, K. B., Scott, D. M., Spinney, J. E., Kanaroglou, P., & Paez, A. (2005). Travel behavior within Canada’s older population: A cohort analysis. Journal of Transport Geography, 13(4), 340–351.Google Scholar
Ontario Ministry of Transportation. (2013). Driving handbook. Retrieved from http://www.mto.gov.on.ca/english/dandv/driver/handbook/section4.2.0.shtml Google Scholar
Organisation for Economic Co-operation Development (OECD). (2001). Ageing and transport: Mobility needs and safety issues. Product Code: 01-RS-03-OECD. Paris, France: Author.Google Scholar
Ott, B. R., Davis, J. D., Papandonatos, G. D., Hewitt, S., Festa, E. K., Heindel, W. C. et al. (2013). Assessment of driving-related skills prediction of unsafe driving in older adults in the office setting. Journal of the American Geriatrics Society, 61(7), 1164–1169.CrossRefGoogle ScholarPubMed
Oxley, J., & Whelan, M. (2008). It cannot be all about safety: The benefits of prolonged mobility. Traffic Injury Prevention, 9(4), 367–378.Google Scholar
Pachana, N. A., & Petriwskyj, A. M. (2006). Assessment of insight and self-awareness in older drivers. Clinical Gerontologist, 30(1), 23–38.Google Scholar
Ragland, D. R., Satariano, W. A., & MacLeod, K. E. (2005). Driving cessation and increased depressive symptoms. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(3), 399–403.Google Scholar
Statutes of Quebec. (2014, c. C-24.2). Regulation respecting access to driving a road vehicle in connection with the health of drivers Highway Safety Code. Retrieved from Société de l’assurance automobile du Québec (SAAQ), http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=%2F%2FC_24_2%2FC24_2R8_A.htm Google Scholar
Schrag, A. (2005). Driving in Parkinson’s disease. Journal of Neurology and Neurosurgery Psychiatry, 76, 159.CrossRefGoogle ScholarPubMed
Scott, D. M., Newbold, K. B., Spinney, J. E., Mercado, R., Perez, A., & Kanaroglou, P. S. (2009). New insights into senior travel behavior: The Canadian experience. Growth and Change, 40(1), 140–168.CrossRefGoogle Scholar
Sims, J., Rouse-Watson, S., Schattner, P., Beveridge, A., & Jones, K. (2012). To drive or not to drive: Assessment dilemmas for GPs. International journal of family medicine (Article ID 41712), 1–6.Google Scholar
Sivak, M. (2013). Female drivers in the United States, 1963–2010: From a minority to a majority? Traffic Injury Prevention, 14(3), 259–260.Google Scholar
Société de l’assurance automobile du Québec (SAAQ). (2014). Road safety is for all ages (ISBN No. 978-2-550-70883-4). Montréal, QC: Bibliothèque nationale du Québec.Google Scholar
Sohlberg, M. (2000). Assessing and managing unawareness of self. Seminars in Speech and Language, 21(2), 135–152.CrossRefGoogle ScholarPubMed
Solomon, R., Chamberlain, E., & Chiodo, S. (2011). Silence may not be golden: A review of health professionals’ statutory obligations to report unfit drivers. Health Law Review, 19(2), 5–16.Google Scholar
Statistics Canada. (2008). Décès dus aux accidents de véhicules à moteur, 1979 à 2004. In Rapport sur la santé. Ottawa, ON: Ramage-Morin, P. L.Google Scholar
Turcotte, M. (2012). Profile of seniors’ transportation habits. Ottawa, ON: Statistics Canada.Google Scholar
Unsworth, C. A., Lovell, R. K., Terrington, N. S., & Thomas, S. A. (2005). Review of tests contributing to the occupational therapy off-road driver assessment. Australian Occupational Therapy Journal, 52(1), 57–74.Google Scholar
Vrkljan, B. H., McGrath, C. E., & Letts, L. J. (2011). Assessment tools for evaluating fitness to drive: A critical appraisal of evidence. Canadian Journal of Occupational Therapy, 78(2), 80–96.CrossRefGoogle ScholarPubMed
Wood, J. M., Worringham, C., Kerr, G., Mallon, K., & Silburn, P. (2005). Quantitative assessment of driving performance in Parkinson’s disease. Journal of Neurology and Neurosurgery Psychiatry, 76, 176–180.CrossRefGoogle ScholarPubMed